Evaluation of a New Automated Aortotomy Closure System for Use in Minimal Access Cardiac Surgery
Joshua K. Wong, MD, Devang J. Joshi, MD, Peter A. Knight, MD.
University of Rochester Medical Center, Rochester, NY, USA.
OBJECTIVE: Aortotomy closure in minimal access cardiac surgery can be challenging. Aortotomies are often not readily accessible with a standard needle-driver and effective surgical knots difficult to hand tie deep within small access sites. Using multiple pre-clinical surgical models, this study evaluated a novel aortotomy closure system, which includes an automated suturing device and specialized titanium suture fasteners.
METHODS: Sequential testing was performed in ex-vivo porcine, in-vivo non-survivor bovine thoracic aorta, survivor ovine ascending aorta and cadaveric surgical models. All live-animal studies were conducted in accordance with IACUC guidelines. The aortotomy closure technique was refined to a single layer running 3-0 polypropylene suture from the lateral edges of the aortotomy to the midline secured with titanium fasteners. In addition to evaluating the technology’s functional mechanisms, surgically relevant factors such as operative angles, closure techniques, aortotomy closure and needle-hole hemostasis in an anti-coagulated animal and successful post-operative aortotomy wound closure were investigated.
RESULTS: Over 50 aortotomy closures were performed in the ex-vivo bench-top porcine model with no system failures observed, yielding satisfactory tissue apposition in all aortotomies. Subsequent live-tissue testing in a non-survivor bovine model demonstrated hemostatic closures in a fully heparinized animal. Aortotomy closures performed in a survivor ovine model demonstrated hemostasis intra-operatively and complete vascular apposition on post-operative day 7. Histologic analysis of the aortotomy revealed tight tissue edge apposition and no evidence of intimal disruption. Lastly, this system was utilized with relative ease in a cadaver via a right anterior mini-thoracotomy for the construction of a successful aortotomy closure.
CONCLUSIONS: This automated aortotomy closure system provided an easily applicable and effective method for aortotomy closure in multiple surgical models. The successful results of this research encourage the future application of remote suturing and knot replacement technology in minimal access cardiac surgery.
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